Reply to Commentaries

Civil war in alcohol policy: Northern versus southern Europe

Stanton Peele

The attitudes of Room and the alcohol public policy field he represents are well-captured
by his slighting reference to John Tierney’s consistently well-written pieces in the New York
Times addressing conflicts of interest. Room (2010) simply dismisses Tierney – a wellinformed
and acute observer of the scientific scene writing for the most influential American
newspaper – on the grounds: ‘‘Mocking quotes from newspaper science writers should
not deflect us . . .’’.

Room thinks it obvious that readers should simply endorse his refusal even to consider the
thoughts of an opinion leader in a venue read by millions of people. Tierney (2010)
addressed exactly this Olympian perspective:

Another reason [for disdain for non-academic-style funding] is a snobbery akin to the old British
aristocracy’s disdain for people ‘‘in trade.’’ Many scientists, journal editors and journalists see
themselves as a sort of priestly class untainted by commerce, even when they work at institutions
that regularly collect money from corporations in the form of research grants and advertising.

This same disdain characterizes Room and his colleagues’ attitudes towards data and
cultural perspectives on alcohol that contradict their own. As I noted in my original piece,
the European Comparative Alcohol Study (ECAS) found more consumption but fewer
problems – even less alcohol-related mortality – in Southern Europe than in Scandinavia.
The ECAS team, led by Room, largely ignored this key finding of their study. While
condescending to incorporate Allamani’s summary in the ECAS volume, Alcohol in Postwar
Europe, Room and the Scandinavian team simply reasserted that alcohol was bad and its
consumption must be reduced – as they have tried to do for decades in Scandinavia.

Unfortunately, for this policy approach, as I described in my piece, Room and
Scandinavian colleagues’ recent research has found the exact opposite of what their
model predicts – a result about which Room makes no mention in his commentary! That is, Bloomfield et al. (2010) found self-reported alcohol problems reduced in Scandinavian
areas where taxes were lowered and limits on returning residents’ carry-home alcohol quota
were removed, a decline not found in a control region (Northern Sweden) where such
change was delayed.

Room and colleagues’ ability to ignore countervailing information, evident in his sneering
dismissal of ‘‘newspaper science writers’’ and the collective disregard for Allamani’s
comments in the ECAS volume – indeed, for the basic findings of the research itself – is
captured by Allamani’s (2010) experiences as a Southern European researcher: ‘‘it is not
often that southern European viewpoints about the culture of drinking are taken into
account in a serious way.’’ He details not only how Northern Europeans have chosen how
to study and interpret the Southern experience with alcohol, but how public policy in the
South was then built on these Northern views!

Ironically, there is no more eloquent description of this iatrogenic process of imposing
external controls than one authored by Room (1988) for a UC San Diego conference, ‘‘Evaluating Recovery Outcomes,’’ in which we both participated:

In comparing Scotland and United States, on the one hand, with developing countries like
Mexico and Zambia, on the other hand, in the World Health Organization Community Response
Study, we were struck with how much more responsibility Mexicans and Zambians gave to family
and friends in dealing with alcohol problems, and how ready Scots and Americans were to cede
responsibility for these human problems to official agencies or to professionals. Studying the
period since 1950 in seven industrialized nations . . . . [when] alcohol problem rates generally grew,
we were struck by the concomitant growth of treatment provision in all of these countries. The
provision of treatment, we felt, became a societal alibi for the dismantling of long-standing
structures of control of drinking behavior, both formal and informal.

What is most fascinating about Allamani’s comment is his detailing of how Italian culture
has actually taken the drinking bull by its horns, influencing it (for instance, in re cirrhosis)
through deep but informal cultural mechanisms: ‘‘We were also convinced that preventive
measures were often affected by the decrease in consumption, rather than the reverse.’’ Beyond this, he brilliantly discusses the different ways in which Northern and Southern
European scientists approach the topic of drinking, to wit, local researchers ‘‘could not
isolate the issue of drinking from everyday life.’’ This statement actually stands as a beacon
to the integration of drinking, culture, and community in both the science and policy
of drinking. Such integration is not a limitation, but instead will be the major thrust of the
science of alcohol use in this century.

Room does no better in dealing with my discussion of disclosure, where he is
disingenuously minimizing. He writes as if the issue were merely wanting ‘‘to know and
take into account the source of funding for a piece of research.’’ I accept such disclosure
(which I have provided here). My argument is with approaches like McCarthyism or
the Hollywood blacklist, where involvement with the alcohol industry (as was once true
for Communistic political involvements) even years earlier can ruin a person’s chances
for publication, employment, or non-industry funding for later research. The editors
of Addiction are clearly angling for this state of affairs, as noted in Gmel’s (2010) caustic
comment, ‘‘The Good, The Bad, and The Ugly,’’ quoted in my piece, but which Room
typically ignores.

There is no better conclusion from this discussion than Allamani’s exquisite final
statement: ‘‘The quality of aims and method, and the clarity of results, should determine the
acceptability of a paper, not an a priori fear or distrust of those who are funded by non-public
sources.’’ Of course, Allamani has a horse in this race. Since government research funding is minimal in Southern Europe, Allamani describes how industry sources have underwritten
major research – the only possibility available. But why would Room and his Northern
European colleagues care about that?

Throughout his commentary, Room does not seem to have taken much time to read
and think about my positions. At the beginning of his comment, it is not clear whether
he intends to tar me with the brush of thinking like outdated early scholars on alcoholism
(whom I critique – as I do Room and his colleagues – for their neo-Temperance attitudes),
or because I am too radical in rejecting Room’s ‘‘soft constructivism’’ (a delightful image).
In re the former, while Room consigns me to the past century, his own horror stories
of industry influence on the NIAAA are from 1976 and 1984.

On the complex topic of what science comprises, I will unfortunately have to be brief.
Room has consistently misunderstood the influence of culture and cognition on addictive
phenomena (as outlined in my book, The Meaning of Addiction). This is a common problem,
because humans are so culture-bound – indeed, that is the subtext of my article. But Room
fundamentally misunderstands the nature of science – just as modern (largely American)
neuroscience does by reifying PET scans as embodying the nature of addiction. Thus he
misconstrues my statement that ‘‘there is no conclusive science . . . ’’ to mean that I am
discarding the idea of objective science altogether.

Instead, my writing recognizes the essential cultural relativity of scientific conceptions
about alcohol’s nature and effects. The entire purpose of my work is to show how inferior
is the work Room endorses by the criteria of empirically falsifiable theory. My goal is to
make the best possible scientific statement, which must incorporate cultural context.
Unfortunately, whereas a cross-cultural scientific model of alcohol use and effects is possible
and desirable, the field has failed to pursue one. This failure is due partly to the culturally
approved acceptance in America of a purely neuroscientific, albeit delusional, explanation
for addiction, along with Room et al.’s internationalistic disregard of cultural variations
in the meanings of alcohol and the experience of drinking. Room and colleagues justify this
disregard (although he spends little time defending it here) by a premature, pseudo-scientific
claim to having established propositions of universal validity. And his and colleagues’ research has now vitiated the very basis for such claims, a result they struggle to explain
(Room et al. 2009).